Provider Demographics
NPI:1083792840
Name:KENNEDY, ALLISON LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 DESEO APT 349
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3011
Mailing Address - Country:US
Mailing Address - Phone:972-424-1480
Mailing Address - Fax:972-424-9117
Practice Address - Street 1:1316 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6206
Practice Address - Country:US
Practice Address - Phone:972-424-1480
Practice Address - Fax:972-424-9117
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical